Senior Consultant, Payment Integrity

The role

You will serve as a subject matter expert and consulting lead on client delivery teams. You will translate payment integrity policy and claims-auditing judgment into working claim-edit rules, review agents, and validation logic.

What you will do

• Own workstreams on client engagements from scoping to implementation
• Lead client discovery sessions, workshops, and executive readouts
• Serve as internal subject matter expert for payment integrity strategy and policy
• Investigate market, industry, and regulatory trends in payment integrity
• Research contracts and design tailored payment integrity strategies and roadmaps
• Create and maintain payment integrity policy for external communication
• Manage client relationships, scope, timelines, and risks
• Partner with Product, Engineering, and Data/Analytics teams to provide market insights
• Configure and validate Payment Integrity accelerators in Snowflake or Databricks environments
• Contribute to consulting methodologies, frameworks, and thought leadership

Required qualifications

• Consulting background at a top-tier global firm or leading healthcare-focused advisory firm
• 5+ years of consulting experience, including client-facing delivery within a healthcare payer practice
• 10+ years of total experience in healthcare payment integrity, claims auditing, or reimbursement analysis
• Knowledge of complex claims auditing workflows and claim types
• Experience developing, writing, and presenting payment integrity policy, strategy, and roadmaps
• Familiarity with provider risk arrangements
• Working knowledge of federal, state, and ERISA regulations
• Experience leading client relationships and engagements
• Bachelor’s Degree

Nice to have

• MBA, MHA, MPH, or comparable advanced degree from a leading institution
• Experience externally representing a firm on payment integrity
• Experience building or scaling a consulting offering
• Six Sigma Black Belt, CPC, CCS, or CFE certification
• Clinical training or an active coding certification (e.g., RHIA, RHIT, CCS)
• Exposure to adjacent payment integrity disciplines
• Exposure to Agile or lean product development environments
• Curiosity about healthcare tech, startups, and company growth
• Exposure to AI or agent-based automation tools

Benefits

• Unlimited paid time off
• Work from anywhere
• Comprehensive health coverage
• Equity for every employee
• Growth-focused environment
• Home office setup allowance
• Monthly cell phone allowance

Before you apply

• Requires current authorization to work in the United States without the need for employer sponsorship
• Interviews are conducted via live video with camera on
• Candidates may be asked to complete identity and location verification

About the company

Abacus Insights is an AI and Data Platform for Payer Intelligence that helps health plans break down data silos. The company aims to make healthcare data usable to improve outcomes and reduce waste.